HISTORIC TEXAS CEMETERY REQUEST FOR DESIGNATION
List additional descriptions or information on separate pages, if necessary.
IDENTIFYING INFORMATION
Primary name: ______________________________
County:
Person completing this form:
Address:
City, State, ZIP:
Phone:
Fax:
Affiliation with cemetery:
Also known as: _____________________________
Date:
Email:
LOCATION
Cemetery address, if known:
City:
Directions to cemetery from nearest town, include distances:
Original Survey Name and Abstract Number:
Optional: Latitude:
Longitude:
TRUSTEESHIP OR CEMETERY ASSOCIATION
Public
Private
Name of individual, political entity, organization, or religious institution associated with cemetery:
Address, City, ZIP:
Association meeting dates, if applicable:
DEED REFERENCE
If known, provide deed information (volume, page, signing date) for deeds that reference the cemetery.
Provide copies.
STATE USE: Cemetery number:
USGS Map:
Feature
Yes  No
Endangerment:  L
M H
OWNERSHIP OF LAND ADJACENT TO CEMETERY
(Indicate on the cemetery map the location of each owner’s property. If there are more than four owners,
please continue on a separate sheet of paper).
Owner No. 1:
Address, City, ZIP:
Owner No. 2:
Address, City, ZIP:
Owner No. 3:
Address, City, ZIP:
Owner No. 4:
Address, City, ZIP:
EXISTING HISTORICAL MARKERS AND GRAVE MARKERS
Provide title and date of each THC historical marker within the cemetery.
Provide title and date of nearby THC historical markers, if any:
SURROUNDING LAND USE (check all that apply)
Urban setting
Suburban setting
Rural setting
Industrial
Level
Sloped
Encroachment
Transitional
Other:
Game preserve
CEMETERY ACCESS (check all that apply)
Direct access to public road
Public access
Private property
Limitations to access:
Primary access:
Walk
Drive Distance from nearest road:
(Name of road)
IDENTIFIABLE CULTURAL HERITAGE (check all that apply)
African American
Asian
European
Hispanic
Jewish
Other:
Language on stones:
Other cultural information:
IDENTIFIABLE RELIGIOUS HERITAGE (check all that apply)
Catholic
Islamic
Jewish
Protestant
Other:
Source:
2
Middle Eastern
(distance)
Native American
LANDSCAPING
Identify the following and note whether the plants are cultural (planted deliberately) or natural growth, if
known.
Trees:
Shrubs:
Cultural
Natural
Cultural
Natural
Cultural
Natural
Cultural
Natural
Cultural
Natural
Cultural
Natural
Cultural
Natural
Cultural
Natural
Groundcover:
PERIMETER
Partially fenced
Fully fenced
Vacant land
Body of water
Rough dimensions:
Cultural
Natural
Cultural
Natural
Cultural
Natural
Cultural
Natural
No fence
Other:
x
feet
Cultivated fields
Trimmed grass
Estimated acreage:
PERIMETER FENCE (if applicable)
Barbed/woven wire
Brick
Cast/wrought iron
Trees
Hedgerow
Wood
Other:
Chain link
Roads
Irregular shape
Resin/synthetic
Stone
AGE AND CONTEXT
Approximate number of graves:
Dates of burials: Oldest
Most recent
Is the cemetery still active?
Yes
No
Unmarked graves
Marked graves, no dates
Dated graves
Associated cultural context existing
(neighborhood, community, church, etc.) Name:
Original geographic context removed (small cemetery now in road right-of-way, parking lot, etc.)
Subsequent community established around cemetery site
Relocated from original site
Source:
Burial records exist
Gravestones have been inventoried
Printed inventory available/location:
CEMETERY CONDITION
Evidence of cemetery above ground
Graves not readily visible
Grave depressions
Overgrown
No obvious evidence of maintenance
Select sections maintained
Trash/dumping ground
Tilted/leaning stones
Fallen stones
Missing features
Evidence of gravestone repairs
GRAVESTONE MATERIALS
Cast iron
Ceramic photographs
Granite
Limestone
Marble
Wood
Tile
Zinc
Other:
Maintained
Vandalized
Concrete
Fieldstone
Funeral company marker
Resin/plastic
Sandstone
Steel
Structural glass
3
CEMETERY FEATURE OVERVIEW
Cemetery sign:
Yes
No
Location?
at the cemetery
on the road
Text:
on gate
on fence
on post
Entry gate:
Yes
No
Gate or arch manufacturer:
Fenced plots:
Family; number:
Individual graves; number:
Interior fence materials:
Barbed wire
Combination
Woven wire
Stone
Curbing:
Cut stone
Grave decoration:
Interior roads:
Concrete
Shells
Dirt
Walkways and paths:
Terracing/retaining walls:
Brick
Gravel
Brick
Dirt
Gravel
Yes
Chain link
Other:
Scraped earth
Brick
Paved
Gravel
Floral
Other:
Cobblestone
Paved
Grass
Stone
Grass
Other:
Other:
No
Segregated burials:
Family
Race
Babies
Institutional
Other:
Cemetery features:
Benches
Grave shrines
Grave slabs
Obelisks
Original statuary
Urns
Well
Other:
Signed statuary; name:
Signed gravestones; name:
Brick
Cast/wrought iron
Wood
Other:
Religion
Fraternal order
Nationality
Pauper
Flagpole
Folk decorations
Fountains
Grave houses
Handcrafted/local castings
Cairns
Mausoleums/vaults
Outhouse
Tabernacle
Structures
Unique stone carving
VETERANS GRAVESTONES
American Revolution
War of 1812
Texas Revolution
Mexican War
Indian Wars
Spanish American War
World War I
World War II
Vietnam War
Gulf War
Afghanistan
Iraq
Other:
4
Civil War
Korean War
HISTORICAL BACKGROUND
Provide a brief history of the cemetery with bibliographic references. Use additional pages if needed.
NOTIFICATION OF COUNTY HISTORICAL COMMISSION
Printed name of CHC chair:
Signature of CHC chair:
Date:
If sending electronically:
Send the application, photos, and supporting
documents as email attachments to:
annette.bethke@thc.state.tx.us.
Be sure to include in the subject line “HTC
application.”
If sending hard copies or disc:
Send the application, photos, supporting documents,
and application fee to:
History Programs Division
Texas Historical Commission
PO Box 12276
Austin, TX 78711-2276
Questions?
History Programs Division
Texas Historical Commission
PO Box 12276, Austin, TX 78711-2276
Phone: 512.463.5853; Fax: 512.475.3122
Email: history@thc.state.tx.us
The Historic Texas Cemetery designation policies are
adopted as Commission rules in the Texas
Administrative Code, Title 13, Chapter 22,
Section 22.6.
12/2010
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